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Predictors of CVD among breast cancer survivors in an integrated health system

综合卫生系统中乳腺癌幸存者 CVD 的预测因素

基本信息

批准号：
9923611
负责人：
Heather Greenlee
金额：
$ 61.87万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-07-15 至 2023-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9923611
关键词：
21 year old Accounting Adherence Affect Age Ancillary Study Anthracycline Antihypertensive Agents Aromatase Inhibitors Arrhythmia Behavior Behavioral Biological Response Modifier Therapy Blood Pressure Breast Cancer Patient Breast Cancer Treatment Breast Cancer survivor California Cancer Control Cancer Prognosis Cardiomyopathies Cardiotoxicity Cardiovascular Diseases Caring Clinical Cohort Studies Common Data Element Common Terminology Criteria for Adverse Events Control Groups Data Databases Diabetes Mellitus Diagnosis Diet Disease Disease Outcome Diuretics Drug usage Dyslipidemias Educational workshop Electronic Health Record Enrollment Ethnic Origin Event Female Funding Healthcare Systems Heart failure Hypertension Iatrogenesis Integrated Health Care Systems Intervention Laboratories Left Length Life Style Link Lipids Literature Longterm Follow-up Malignant Neoplasms Medical Minority Myocardial Ischemia Myocarditis National Heart, Lung, and Blood Institute Observational Study Pathway interactions Patients Pericarditis Pharmaceutical Preparations Physical activity Race Radiation therapy Recording of previous events Relative Risks Research Design Risk Risk Behaviors Risk Factors Side Smoking Socioeconomic Status Stroke Subgroup Tamoxifen Transient Ischemic Attack Trastuzumab Treatment Factor Treatment Protocols Treatment-Related Cancer Woman base breast cancer diagnosis cancer therapy cardiovascular disorder risk chemotherapy clinical risk cohort comorbidity comparison group data resource diet and exercise fasting glucose follow-up hazard health plan high risk hormone therapy improved improved outcome lifestyle factors malignant breast neoplasm medication compliance member patient population response sudden cardiac death venous thromboembolism

项目摘要

PROJECT SUMMARY / ABSTRACT Breast cancer survivors are at high risk of developing and dying from cardiovascular disease (CVD) following breast cancer diagnosis, but subpopulations at increased risk and targets for intervention have not been well- characterized. A growing body of literature links CVD with specific cardiotoxic cancer treatments. CVD risk among breast cancer survivors might vary by concomitant non-adherence to CVD medications and presence of CVD risk factors. However, most of the studies on CVD risk among breast cancer patient populations have had significant limitations, including poorly characterized CVD outcomes, lack of CVD medication adherence data and risk factors, and poorly matched cancer-free control groups. Well-designed studies are needed to identify subpopulations of breast cancer survivors at high risk for CVD events and modifiable targets for intervention while accounting for specific breast cancer treatments received, CVD medications, and CVD risk factors. We propose to conduct an ancillary study within an ongoing study of breast cancer survivors which will overcome limitations of prior studies. The proposed study will comprehensively examine clinical and behavioral predictors of CVD outcomes among breast cancer survivors, and will maximize unique patient and data resources available at Kaiser Permanente Northern California (KPNC). We will compare CVD events in the Pathways Study, a cohort of female KPNC members age ≥21 years diagnosed with invasive breast cancer (n=4,453, R01CA105274) with CVD events in a new age, race/ethnicity, history of comorbidity, and length of KPNC membership matched cohort of healthy KPNC female members (n=22,265). Specific aims are: Aim 1) To examine the absolute risk and relative risk of incident CVD events (ischemic heart disease, stroke/transient ischemic attack, and cardiomyopathy/heart failure, and others) and new onset CVD risk factors (hypertension, diabetes, dyslipidemia) in women with breast cancer (Pathways) and a cancer-free comparison group (KPNC matched cohort); Aim 2) In women with a history of breast cancer (Pathways), to examine the relative risk of incident CVD events and new onset of CVD risk factors, by type of cardiotoxic breast cancer treatment received, including chemotherapy/biologic therapy (anthracyclines, trastuzamab), hormonal therapy (Tamoxifen, aromatase inhibitors), and radiation therapy, controlling for confounders related to baseline CVD medication adherence, clinical and behavioral risk factors, medical care and health care system factors, and socioeconomic status (SES); Aim 3) To assess adherence to CVD medications in women with a history of breast cancer (Pathways) using 14 years of follow-up data, and to examine the association of adherence with risk of CVD events controlling for cardiotoxic cancer treatment received, baseline CVD clinical and behavioral risk factors, medical care and health care system factors, and SES. Impact: Results from this study will have important implications for identifying breast cancer subgroups at high risk of CVD and identifying potential targets for intervention, such as medication adherence and control of CVD risk factors.

项目总结/摘要乳腺癌幸存者在以下情况下发生和死于心血管疾病（CVD）的风险很高乳腺癌诊断，但风险增加的亚群和干预目标尚未得到很好的- 表征了越来越多的文献将CVD与特定的心脏毒性癌症治疗联系起来。CVD风险在乳腺癌幸存者中， CVD危险因素。然而，大多数关于乳腺癌患者人群心血管疾病风险的研究有明显的局限性，包括CVD结局特征不佳，缺乏CVD药物依从性数据和风险因素，以及匹配不佳的无癌对照组。需要精心设计的研究，确定CVD事件高风险的乳腺癌幸存者亚群和干预，同时考虑接受的特定乳腺癌治疗，CVD药物和CVD风险因素我们建议在正在进行的乳腺癌幸存者研究中进行一项辅助研究，克服了以往研究的局限性。这项研究将全面检查临床和行为乳腺癌幸存者中CVD结局的预测因子，并将最大限度地利用独特的患者和数据在Kaiser Permanente北方加州（KPNC）可用的资源。我们将比较CVD事件在路径研究，一项年龄≥21岁诊断为浸润性乳腺癌的女性KPNC成员队列（n= 4，453，R 01 CA 105274）在新的年龄、人种/种族、合并症史和病程中发生CVD事件 KPNC成员匹配的健康KPNC女性成员队列（n= 22，265）。具体目标是：目标1）检查CVD事件（缺血性心脏病、卒中/一过性）的绝对风险和相对风险缺血性发作和心肌病/心力衰竭等）和新发CVD危险因素（高血压，糖尿病、血脂异常）的乳腺癌女性（Pathways）和无癌对照组（KPNC 匹配队列）;目的2）在有乳腺癌病史的女性中（路径），检查按心脏毒性乳腺癌治疗类型列出的新发CVD事件和新发CVD风险因素接受的治疗，包括化疗/生物治疗（蒽环类、曲妥珠单抗）、激素治疗（他莫昔芬，芳香酶抑制剂）和放射治疗，控制与基线CVD相关的混杂因素药物依从性、临床和行为风险因素、医疗保健和卫生保健系统因素，以及社会经济地位（SES）;目的3）评估有以下病史的女性对CVD药物的依从性：乳腺癌（途径）使用14年的随访数据，并检查依从性与 CVD事件的风险，控制接受的心脏毒性癌症治疗，基线CVD临床和行为风险因素、医疗保健和卫生保健系统因素以及SES。影响：本研究的结果将对确定CVD高风险乳腺癌亚组和确定潜在的干预目标，如药物依从性和CVD风险因素的控制。